POS0874 GLUCOCORTICOIDS PRESCRIBING PRACTICES IN SYSTEMIC SCLEROSIS: AN ANALYSIS OF THE EUSTAR DATABASE.
Authors: M. Iudici, D. Mongin, E. Siegert, P. Carreira, J. H. W. Distler, J. Henes, E. Zanatta, E. Hachulla, G. De Luca, C. Souza Muller, M. J. Salvador, J. L. Tandaipan, B. Valdetaro Bianchi, M. De Santis, A. M. Hoffmann-Vold, A. Gabrielli, O. Distler, D. Courvoisier
Journal: Annals of the Rheumatic Diseases (2022)

Background The use of glucocorticoids (GC) in systemic sclerosis (SSc) is controversial (1). Despite the lack of solid evidence about their efficacy in SSc, GC are prescribed to control musculoskeletal symptoms, or in combination with immunosuppressive drugs (1). The extent of GC use over the disease course has been poorly investigated in SSc. As long-term GC exposure is detrimental even at low doses, estimating the use of GC and identifying patients at high risk for long-term utilization is crucial to plan better management of SSc patients. Objectives To estimate the prevalence of GC use in a large sample of SSc patients, identify patient characteristics associated with time spent on GC, and describe the variations in GC utilization over time and across main recruiting countries. Methods We included SSc patients with at least one visit in the EUSTAR database from January 2013 (defined as baseline visit) to November 2019. We analyzed the prevalence and the main features of patients using GC at baseline, and the exposure to GC over time. Multivariable linear regression analysis identified patient characteristics associated with the proportion of follow-up time spent on GC. Time trends and variations in GC utilization across main recruiting countries were explored. Missing data were imputed using multiple imputation with chained equations. Results The 9819 patients included were mostly females (85%), with limited cutaneous (lc) SSc (73%), and median age of 58 years. At baseline, 2769 (34%) patients (48% diffuse cutaneous (dc) SSc vs. 29% lcSSc) were on GC, at a median dose 7.5 mg/day [IQR 5-9 mg]. Only 2% of patients (n = 162) received &gt;15 mg/day prednisone equivalent. GC were mostly used in combination with an immunosuppressive drug, mainly methotrexate (29%), cyclophosphamide (21%), and mycophenolate mofetil (21%). Compared to patients not receiving GC at baseline, GC users were more frequently males (18% vs. 14%), anti-Scl70 positive (42% vs. 27%), had more synovitis (21% vs. 8%), pericardial effusion (9% vs. 5%), C-reactive protein elevation (33% vs. 19%), increased CK (12% vs. 8%), and significantly lower respiratory volumes. In the subgroup of patients with an early disease duration (&lt; 3 years from first non-Raynaud’s onset) (n = 1896), the prevalence of GC users was similar to that observed in the entire sample, but more dcSSc patients were receiving GC in combination with immunosuppressors. On average, GC users spent 25% of their follow-up time (median 33.2 months) on GC, with no significant difference between lcSSc and dcSSc patients. Notably, 971 (33%) and 647 (22%) patients followed-up for &gt;1 year received GC for &gt;6 or &gt;12 months, respectively. In multivariable analysis, patient characteristics poorly explained the variability of GC exposure (adjusted-R 2 = 0.062, P &lt; 0.001). The yearly proportion of glucocorticoids users (2013 - 2018) gradually decreased over time (36% in 2013 vs. 23% in 2018). The rate of GC users and the median proportion of follow-up time spent on GC was highly heterogeneous within and across countries. Conclusion GC are widely and long-term used in SSc, mainly to patients with dcSSc, with significant between- and within-country(ies) differences. A gradual decrease in their utilization over time is observed. References [1]Iudici M, et al. Glucocorticoids in systemic sclerosis: weighing the benefits and risks - a systematic review. Clin Exp Rheumatol. 2013;31(2 Suppl 76):157-65. Disclosure of Interests Michele Iudici: None declared, Denis Mongin: None declared, Elise Siegert: None declared, Patricia Carreira: None declared, Jörg H.W. Distler: None declared, Jörg Henes Speakers bureau: Roche/Chugai, Janssen, Neovii and Boehringer-Ingelheim, Elisabetta Zanatta: None declared, Eric Hachulla Speakers bureau: speaking fees from Johnson &amp; Johnson, GSK, Roche-Chugai; and research funding from CSL Behring, GSK, Roche-Chugai and Johnson &amp; Johnson., Consultant of: consulting fees/meeting fees from Johnson &amp; Johnson, Boehringer Ingelheim, Bayer, GSK, Roche-Chugai, Sanofi-Genzyme, Giacomo De Luca: None declared, CAROLINA SOUZA MULLER Speakers bureau: speaker for Janssen and Boehringer-Ingelheim, Maria Joao Salvador: None declared, Jose Luis Tandaipan: None declared, Breno Valdetaro Bianchi: None declared, Maria De Santis: None declared, Anna-Maria Hoffmann-Vold Speakers bureau: A-MH-V reports research funding, consulting fees, or other remuneration from Actelion, Boehringer Ingelheim, Roche, Bayer, Merck Sharp &amp; Dohme, ARXX therapeutics, Lilly, and Medscape., Consultant of: A-MH-V reports research funding, consulting fees, or other remuneration from Actelion, Boehringer Ingelheim, Roche, Bayer, Merck Sharp &amp; Dohme, ARXX therapeutics, Lilly, and Medscape., Grant/research support from: A-MH-V reports research funding, consulting fees, or other remuneration from Actelion, Boehringer Ingelheim, Roche, Bayer, Merck Sharp &amp; Dohme, ARXX therapeutics, Lilly, and Medscape., Armando Gabrielli: None declared, Oliver Distler Speakers bureau: OD has/had consultancy relationship with and/or has received research funding from or has served as a speaker for the following companies in the area of potential treatments for systemic sclerosis and its complications in the last three years: Abbvie, Acceleron, Amgen, AnaMar, Arxx, Baecon, Blade, Bayer, Boehringer Ingelheim, ChemomAb, Corbus, CSL Behring, Galapagos NV, Glenmark, GSK, Horizon (Curzion), Inventiva, iQvia, Italfarmaco, Kymera, Medac, Medscape, Mitsubishi Tanabe, MSD, Novartis, Pfizer, Roche, Roivant, Sanofi, Serodapharm, Topadur, Target Bioscience and UCB. Patent issued “mir-29 for the treatment of systemic sclerosis” (US8247389, EP2331143)., Consultant of: OD has/had consultancy relationship with and/or has received research funding from or has served as a speaker for the following companies in the area of potential treatments for systemic sclerosis and its complications in the last three years: Abbvie, Acceleron, Amgen, AnaMar, Arxx, Baecon, Blade, Bayer, Boehringer Ingelheim, ChemomAb, Corbus, CSL Behring, Galapagos NV, Glenmark, GSK, Horizon (Curzion), Inventiva, iQvia, Italfarmaco, Kymera, Medac, Medscape, Mitsubishi Tanabe, MSD, Novartis, Pfizer, Roche, Roivant, Sanofi, Serodapharm, Topadur, Target Bioscience and UCB. Patent issued “mir-29 for the treatment of systemic sclerosis” (US8247389, EP2331143)., Grant/research support from: OD has/had consultancy relationship with and/or has received research funding from or has served as a speaker for the following companies in the area of potential treatments for systemic sclerosis and its complications in the last three years: Abbvie, Acceleron, Amgen, AnaMar, Arxx, Baecon, Blade, Bayer, Boehringer Ingelheim, ChemomAb, Corbus, CSL Behring, Galapagos NV, Glenmark, GSK, Horizon (Curzion), Inventiva, iQvia, Italfarmaco, Kymera, Medac, Medscape, Mitsubishi Tanabe, MSD, Novartis, Pfizer, Roche, Roivant, Sanofi, Serodapharm, Topadur, Target Bioscience and UCB. Patent issued “mir-29 for the treatment of systemic sclerosis” (US8247389, EP2331143)., Delphine Courvoisier: None declared